– The coronavirus pandemic is helping to shine the spotlight on the use of telehealth and mHealth to improve care coordination in places ranging from a patient’s home to an accident scene.
With COVID-19 patients, providers are using a teletriage platform to diagnose patients at home and develop care management plans that can evolve into remote patient monitoring programs. These same tools have been used by first responders, meanwhile, to improve care coordination in the field, reducing ER transports and improving care outcomes for people who spend a lot of time going to and from the hospital.
“First responders have a great opportunity to use telehealth in ways that we really haven’t seen before,” says Carl Marci, chief medical officer for Ready, a two-year-old provider of mobile healthcare services that has seen business skyrocket during the coronavirus. “We’re redefining the house call for a whole generation who doesn’t even know what a house call is.”
Originally created to help communities, businesses and other organizations dispatch care providers to the home or other locations for non-emergency medical issues, the company launched a “COVID-19 fast lane” service to screen patients suspected of having the virus at home. They’re now partnering with municipal authorities in locations like New York, Las Vegas, Baltimore, Washington DC, Reno and New Orleans (where they work with Ochsner Health).
“This model of care is ideal” for a pandemic, says Marci.
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Beyond COVID-19, Marci touts the success of programs with hospitals and community health centers to bring care to the homes of people with multiple chronic conditions – sometimes called “frequent flyers” for the amount of time they spend in hospitals. These mobile integrated health programs, he says, can reduce ED transports by as much as 50 percent by focusing on health and wellness and addressing the social determinants that create health issues.
“You’re building relationships with people” who often don’t see those types of interactions in the emergency room, he points out. “You’re helping people to understand how to take better care of themselves and how to decide when to go to the ER and when there’s a better way” of accessing care.
That’s especially important during the COVID-19 crisis, he says, when people are avoiding the ER out of fear of the virus and aren’t getting the care they need – or they’re going to the ER and unnecessarily putting their lives at risk. In New Orleans, for example, a survey found that some 70 percent of the people served by Ready would have otherwise headed to the hospital.
“This is a new way of delivering care for a lot of people,” says Marci, who’s now fostering a direct-to-consumer service line and envisions future programs that address mental health, pediatric and maternity concerns.
Mobile integrated health programs, which focus on bringing healthcare and other services to the home to improve health and wellness and reduce unnecessary 911 calls and doctor’s office visits, have been around for a few years. COVID-19 has given them more of a spotlight, as health systems look to reduce traffic in the hospital while still providing chronic care management.
Putting Community Paramedicine to Work
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In Pueblo, CO, Parkview Medical Center launched a partnership with the Pueblo Fire Department to create Directing Others to Services, of DOTS. The hospital-funded community paramedicine program, which identifies and provides home-based care for frequent flyers, has halved 911 calls – all but eliminating unnecessary transports – and saving the health system thousands of dollars.
“What we’re finding is that people aren’t connected to resources in their community,” says Kelly Firestone, Parkview’s community Risk reduction coordinator. “We find the barriers that exist in their lives and we break through those barriers.”
Firestone, who visits the homes of recently discharged patients identified as ideal candidates for DOTS, sees many different barriers to care, from transportation issues to an unhealthy or challenging home life.
“These problems aren’t being fixed in the emergency room,” she says.
Kelea Nardini, Parkview’s assistant vice president of quality and post-acute care, says the program helps these patients find the resources they need to maintain a healthier lifestyle at home. That often includes access to primary care providers, pharmacies and social workers, and soon will include telehealth access to substance abuse counselors, mental health counselors and other care providers.
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“We’re a community-based care transition program, with the emphasis on community,” she says. “We take care of our community.”
They point out that DOTS, which was launched in 2015, was originally intended to last just three months, but they found that each patient’s needs are very different and have to be addressed as such – one person might need just one or two visits, while another might need frequent check-ups for six or nine months.
“We know these people, and who does what they say they’re going to do?” Firestone says.
Pueblo Fire Chief Barb Huber says the program slowed down a bit when COVID-19 surfaced just because no one knew how to manage it in the midst of a pandemic. They quickly realized, however, that the program would be even more important to seniors and those with ongoing care needs who couldn’t venture outdoors or were scared of doing so.
“The message is critical right now that people still do need to take care of themselves,” she says. “They still need to see their doctor. And we have a program here that is a critical part to the community because it serves that need.”
Giving Mobile Integrated Health a National Platform
While the pandemic has allowed more communities to experiment with mobile integrated health programs, it has also highlighted the challenges those programs face – particularly around federal recognition and funding.
The Centers for Medicare & Medicaid Services recognized that need when it introduced the Emergency Triage, Treat and Transport (E3) payment model in late 2019. CMS had planned to enroll some 200 healthcare providers, including health systems and EMS providers, in the program, to study how connected health tools could be used to reduce unnecessary 911 transports and improve care coordination for Medicare beneficiaries.
CMS put a hold on that program when COVID-19 took over, but some say it was flawed from the start, and needs to be redesigned.
“Is this really a value-based care model?” asks Jonathan Feit, co-founder and CEO of Beyond Lucid Technologies, a develop of mHealth technology for EMS providers. “They focused on the how but left out the why, which is the most important part.”
Feit, whose company has been partnering with communities across the country to improve EMS response and care coordination during the pandemic, says federal support has focused on the idea of better managing transportation for patients.
“That’s a travel-based model,” he says. “They want to know where I took you instead of why I took you there or how did I do.”
Feit says CMS has to understand the root causes for shifting transports away from the ER, and that delves into examining what factors lead up to a 911 call and what healthcare resources can be used to avoid those calls and better serve patients after they’ve made the call.
“They have to recognize that EMS is not just a first responder but an extension of the health system,” he says.
With COVID-19 closing or restricting many hospitals and clinics, many health systems and EMS providers have practically been forced to look at other ways to help patients in need of care. If the ER is filled with coronavirus patients or closed, there has to be an alternate route to care. That’s where mobile integrated health comes into play.
“COVID-19 is a catalyst,” Feit says. “The virus has forced people to challenge their assumptions in ways that they’ve never done before.”
That, he says, may lead to further refinements in the mobile integrated health model, and maybe even scrapping the E3 program in favor of a better model, based on lessons learned from COVID-19.
Feit sees syndrome surveillance and chronic care management as community paramedicine 2.0. On the horizon, he says, will be a model – community paramedicine 3.0 – that addresses and even bigger need in healthcare: mental health and substance abuse.
“This is a wake-up call for healthcare,” he says.